Oesophageal obstruction: stenosis, webs, rings, diverticula
- Lesion
Scars, thin shelves of lining, rings and pouches can narrow the oesophagus and make food stick.
What it is
The oesophagus can be blocked physically or functionally. Physical causes include benign strictures, mucosal webs, Schatzki rings and diverticula; functional causes are disorders of peristalsis. Patients with physical obstruction typically have trouble with solids first and liquids later, whereas motor disorders affect both from the start.
Structure
- Stricture: dense submucosal fibrous tissue, atrophic muscularis and damaged overlying epithelium.
- Web: a ledge of mucosa with a vascular fibrous core; no muscle.
- Ring: mucosa and submucosa, sometimes hypertrophic muscle.
- Zenker: mucosa and submucosa bulging posteriorly through a weak area of the pharyngeal wall.
Structural causes of oesophageal obstruction
| Lesion | Layers involved | Where | Associations |
|---|---|---|---|
| Benign stricture | Submucosal fibrosis | Usually distal | Chronic reflux, caustic injury, radiation, eosinophilic oesophagitis |
| Web | Mucosa only | Upper or mid oesophagus | Plummer–Vinson syndrome, reflux, graft-versus-host disease, blistering skin disease |
| Schatzki ring | Mucosa, submucosa, sometimes muscle | Distal oesophagus or squamocolumnar junction | Food bolus impaction |
| Zenker diverticulum | Mucosa and submucosa (false) | Just above the upper sphincter | Regurgitation, bad breath, aspiration |
| Epiphrenic diverticulum | Mucosa and submucosa (false) | Just above the lower sphincter | Spasm and other motor disorders |
Clinical notes
- Zenker diverticulum causes regurgitation of undigested food, halitosis and aspiration.
- A food bolus stuck at a ring in a young adult should also prompt a search for eosinophilic oesophagitis.
Test yourself
Think of the answer, then tap the question to see it.
Which triad defines Plummer–Vinson syndrome?
An upper oesophageal web with iron deficiency anaemia, plus glossitis and cheilosis; it raises the risk of squamous cell carcinoma.
Is Zenker diverticulum a true or a false diverticulum?
False: only mucosa and submucosa herniate, above the upper oesophageal sphincter.
How do webs and Schatzki rings differ in their wall layers?
Webs are mucosa only; rings are thicker and include submucosa and sometimes muscle.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Esophageal stricture - benign: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Anatomy, Thorax, Esophagus (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.